Nadia Peparini, Azienda Sanitaria Locale Roma H, via Mario Calo' 5 - 00043 Ciampino, Italy, Italy.
World J Gastroenterol. 2013 Dec 21;19(47):8996-9002. doi: 10.3748/wjg.v19.i47.8996.
Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract. Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery, an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes, lymph node ratio, number of negative nodes, ratio of negative to positive nodes, and log odds, i.e., the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive carcinomas. As lymphadenectomy is not without complications, sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be preferred. However, due to anatomical and technical issues, sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive cancer. Moreover, in light of the biological, prognostic and therapeutic impact of tumor budding and tumor deposits, two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression, the role of staging and surgical procedures in digestive carcinomas could be redefined.
淋巴结受累是消化道癌最重要的预后指标之一。尽管淋巴结清扫术的治疗效果尚未得到证实，并且检出的淋巴结数量不能作为癌症手术成功的衡量标准，但为了通过受累淋巴结的数量、淋巴结比率、阴性淋巴结数量、阴性与阳性淋巴结比率以及对数优势（即阳性淋巴结数量与阴性淋巴结数量之比的对数）准确评估 N 期，应保证足够的淋巴结计数。由于淋巴结清扫术并非没有并发症，因此前哨淋巴结绘图已被用作选择早期消化道癌患者的合理程序，这些患者可能可以省略淋巴结清扫术，或者可以选择更有限的淋巴结清扫术。然而，由于解剖和技术问题，前哨淋巴结绘图和淋巴结盆部清扫术尚未成为早期消化道癌的常规治疗方法。此外，鉴于肿瘤芽和肿瘤沉积物的生物学、预后和治疗影响，这是两种涉及肿瘤进展的上皮-间充质转化相关现象，肿瘤分期和手术程序在消化道癌中的作用可能需要重新定义。
